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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Soft-tissue management in revision total shoulder arthroplasty
Joseph A Abboud1, Oke A Anakwenze, Jason Edward Hsu
1Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
The Journal of the American Academy of Orthopaedic Surgeons
|January 3, 2013
Summary
Revision total shoulder arthroplasty is complex, with outcomes often inferior to primary procedures, especially for soft-tissue issues. Careful patient selection and a structured approach are crucial for managing stiff or unstable shoulder replacements.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Musculoskeletal Research
Background:
- Revision total shoulder arthroplasty presents significant surgical challenges.
- Outcomes are generally inferior compared to primary shoulder arthroplasty, particularly when soft-tissue problems are the indication for revision.
Purpose of the Study:
- To outline an organized diagnostic and management approach for stiff or unstable revision total shoulder arthroplasty.
- To highlight the importance of patient selection and addressing specific soft-tissue issues in revision cases.
Main Methods:
- Review of challenges in revision total shoulder arthroplasty.
- Discussion of indications for revision, including stiffness and instability.
- Consideration of soft-tissue factors such as rotator cuff and capsular contractures, adhesions, and deficiencies.
Main Results:
- Revision surgery is technically demanding.
- Soft-tissue problems significantly impact revision outcomes.
- Infection must be ruled out in failed total shoulder arthroplasty cases.
Conclusions:
- An organized approach is essential for diagnosing and managing failed total shoulder arthroplasty.
- Addressing rotator cuff and capsular issues is critical for successful revision surgery.
- Increasing numbers of shoulder arthroplasties will necessitate more revision procedures.